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Polymeric clips versus staplers for appendiceal stump closure in laparoscopic appendectomy: a retrospective
Şebnem Çimen1, Kemal Berkay Tekin2, Ahmet Kamburoğlu3
1General Surgery Department, Akyurt State Hospital, Ankara, Turkey. sebnemay93@gmail.com.
Purpose:
The aim of this study was to compare non-absorbable polymeric clips and endostapler techniques used for appendiceal stump closure in laparoscopic appendectomy and to evaluate the outcomes of both methods in terms of clinical safety, complication rates, appendiceal diameter, histopathological stage and cost-effectiveness. Within this scope, the study aimed to determine the most appropriate stump closure technique that could minimize costs while maintaining surgical safety.
Method:
Data from 692 adult patients who underwent laparoscopic appendectomy for acute appendicitis in the general surgery department between January 2022 and December 2024 were retrospectively reviewed. The patients' demographic and clinical characteristics, appendiceal diameter, operative time, stump closure technique, postoperative complications, Clavien-Dindo classification, and pathological findings were recorded. Data were analyzed using the SPSS software version 25.0 and a p-value of < 0.05 was considered statistically significant.
Results:
Polymeric clips were used in 87.6% of the patients, while staplers were used in 12.4%. In the stapler group, age (p < 0.001), Charlson Comorbidity Index (p < 0.001), CRP level (p < 0.001), appendiceal diameter (p < 0.001), and operative time (p = 0.003) were significantly higher. Intraoperative perforation was observed in 53.5% of patients in the stapler group and in 16.7% of those in the clip group (p < 0.001). The overall complication rates were similar between the two groups (p = 0.089). In the subgroup of perforated appendicitis cases (n = 146), no significant differences were observed in complication rates (p = 0.601) or Clavien-Dindo grades (p = 0.653). The mean cost of the polymeric clip was 2.33 USD, whereas the cost of the stapler was 31.35 USD (p < 0.001).
Conclusion:
Polymeric clips represent a safe and cost-effective option for appendiceal stump closure in laparoscopic appendectomy. Postoperative outcomes were similar across techniques, although staplers tended to be used in more complex intraoperative situations.
